Department File Number : | M201574804 |
Claim Number : | 11-0104-A-09 |
Date Submitted : | 1/19/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
FD INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-3704679 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Tamla | Lloyd | |||
Street Address | |||||
4651 Salisbury Road, Suite 410 | |||||
City | State | Zip | |||
Jacksonville | FL | 32256 | |||
Phone | Ext | Fax | E-Mail Address | ||
(904) 296 - 2887 | 212 | (904) 296 - 1245 | tlloyd@fdinsurancecompany.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | VIRGIL | DAWSON | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 515 W. State Rd. 434, Suite 301 | ||||
City | State | Zip Code | County | ||
Longwood | FL | 32750 | Seminole | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
MS001062 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME47263 | Family Physicians or General Practitioners - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Seminole | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Emergency Room | |||||
Name of Institution | Code | ||||
SOUTH SEMINOLE HOSPITAL | 100263 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | South Seminole Hospital | ||||
Date of Occurrence | Date Reported to Insurer | ||||
12/23/2009 | 5/17/2011 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
On 12/15/09, the pt was presented to the ER at South Seminole hospital with radiating chest pain. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
None shown | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
None made | |||||
Principal Injury Giving Rise To The Claim | |||||
Alleged failure to properly and timely treat impending heart attack. | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
10/26/2011 | 11-CA-3958-09-G | ||||
County Suit Filed in | Date of Final Disposition | ||||
Seminole | 5/13/2015 | ||||
Other Defendants Involved in this Claim | |||||
Longwood Family Medicine, PA Parekh , Rakesh S Emergency Physicians of Central Florida Orlando Health, Inc., A Florida Corporation d/b/a South Semi | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference. | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
5/13/2015 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $240,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $80,703 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Circumstances of this case have been discussed with the insured and risk management was notified. Risk management has discussed case with insured. |
Updates | |||||||
Date of Change: | 1/19/2016 3:54:24 PM | ||||||
Reason for Change: | Updated LAE amount. | ||||||
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Does Dr. VIRGIL DAWSON, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. VIRGIL DAWSON, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).